Theories of Change in Global Health

Abstract This book offers a systematic characterization and critical review of the theories of change that underlie global health interventions. The health of a community is a product of multiple complex interacting economic, political, environmental, cultural, historical, geographical, and institutional forces. How a particular intervention intended to improve health will interact within this complex system is often unstated. This book helps readers recognize underlying theories of change. This book offers a language and framework around 15 theories of change that commonly underlie global health interventions. These theories include health systems strengthening, external aid, healthy regulations, improving governance, knowledge dissemination, behavior change, technology, economic growth, cash transfer, modifying prices, social entrepreneurship, advocacy, global health initiatives, response to crisis, and strategic research. Each chapter reviews multiple case studies of success in improving community health with interventions based on that chapter’s theory of change, and then reviews multiple case studies of failure to improve community health with the same theory. The chapters then leverage these case studies to offer tentative guidance on conditions that predispose to success or failure for that theory of change. For readers considering a specific global health problem, the book aims to broaden the approaches under consideration that history suggests might be useful. It calls on those who plan interventions to defend their approach in light of historical failures and plausible alternatives.